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  • 1.
    Eklund, Linda M.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Department of Anesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden.
    Sköndal, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Tufvesson, Ellen
    Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden.
    Sjöström, Rita
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Söderström, Lars
    Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden.
    Hanstock, Helen G.
    Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden.
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Stenfors, Nikolai
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Cold air exposure at -15 °C induces more airway symptoms and epithelial stress during heavy exercise than rest without aggravated airway constriction2022Ingår i: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 122, nr 12, s. 2533-2544Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Exposure to cold air may harm the airways. It is unclear to what extent heavy exercise adds to the cold-induced effects on peripheral airways, airway epithelium, and systemic immunity among healthy individuals. We investigated acute effects of heavy exercise in sub-zero temperatures on the healthy airways.

    Methods: Twenty-nine healthy individuals underwent whole body exposures to cold air in an environmental chamber at − 15 °C for 50 min on two occasions; a 35-min exercise protocol consisting of a 5-min warm-up followed by 2 × 15 min of running at 85% of VO2max vs. 50 min at rest. Lung function was measured by impulse oscillometry (IOS) and spirometry before and immediately after exposures. CC16 in plasma and urine, and cytokines in plasma were measured before and 60 min after exposures. Symptoms were surveyed pre-, during and post-trials.

    Results: FEV1 decreased after rest (− 0.10 ± 0.03 L, p < 0.001) and after exercise (− 0.06 ± 0.02 L, p = 0.012), with no difference between trials. Exercise in − 15 °C induced greater increases in lung reactance (X5; p = 0.023), plasma CC16 (p < 0.001) as well as plasma IL-8 (p < 0.001), compared to rest. Exercise induced more intense symptoms from the lower airways, whereas rest gave rise to more general symptoms.

    Conclusion: Heavy exercise during cold air exposure at − 15 °C induced signs of an airway constriction to a similar extent as rest in the same environment. However, biochemical signs of airway epithelial stress, cytokine responses, and symptoms from the lower airways were more pronounced after the exercise trial.

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  • 2.
    Eklund, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Schagatay, Filip
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Tufvesson, Ellen
    Sjöström, Rita
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Söderström, Lars
    Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden.
    Hanstock, Helen G.
    Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Stenfors, Nikolai
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    An experimental exposure study revealing composite airway effects of physical exercise in a subzero environment2021Ingår i: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 80, nr 1, artikel-id 1897213Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Exposure to a cold climate is associated with an increased morbidity and mortality, but the specific mechanisms are largely unknown. People with cardiopulmonary disease and winter endurance athletes are particularly vulnerable. This study aimed to map multiple domains of airway responses to exercise in subzero temperature in healthy individuals.

    Thirty-one healthy subjects underwent whole-body exposures for 50 minutes on two occasions in an environmental chamber with intermittent moderate-intensity exercise in +10 °C and -10 °C. Lung function, plasma/urine CC16 , and symptoms were investigated before and after exposures.

    Compared to baseline, exercise in -10 °C decreased FEV1 (p=0.002), FEV1/FVC (p<0.001), and increased R20Hz (p=0.016), with no differences between exposures. Reactance increased after +10 °C (p=0.005), which differed (p=0.042) from a blunted response after exercise in -10 °C. Plasma CC16 increased significantly within exposures, without differences between exposures. Exercise in -10 °C elicited more intense symptoms from the upper airways, compared to +10 °C. Symptoms from the lower airways were few and mild. 

    Short-duration moderate-intensity exercise in -10 °C induces mild symptoms from the lower airways, no lung function decrements or enhanced leakage of biomarkers of airway epithelial injury, and no peripheral bronchodilatation, compared to exercise in +10 °C. 

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  • 3.
    Eriksson, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Schagatay, Filip
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Sjöström, Rita
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Soderstrom, Lars
    Hanstock, Helen
    Sandström, Thomas
    Department of Medicine, Respiratory & allergy unit, Umeå university hospital, Umeå, Sweden.
    Stenfors, Nikolai
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Symptoms of moderate exercise in subzero temperatures - An experimental exposure study2018Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Humans react to cold with various symptoms. Previous studies enquiring about symptoms during cold exposure have for the most part been population based studies using questionnaries and have focused on a narrow spectrum of symptoms. The purpose of this study was to study the effect of cold air and physical exercise on a wide range of symptoms in healthy individuals.

    A total of 31 healthy subjects were experimentally exposed to +10 °C and -10 °C in an environmental chamber for one hour, on two separate occasions. During each exposure, subjects performed an intermittent moderate-intensity running protocol between 62-78% of maximal oxygen consumption (VO2 max). At five timepoints, before, during and after the exposures, subjects were asked about 18 symptoms and their intensity. The Borg CR10 scale was used to rate the intensity from 0 to 11, where 0 meant "none" and 11 meant "maximal". The sum of all five Borg CR10-scores were added together to form a single score for each exposure. Paired Wilcoxon signed-rank test was used for analysis. Data are presented as medians.

    Symptoms of cough, eye irritation, physical discomfort, and cold extremities were present only at -10 °C. Compared to exercise in +10 °C, exercise in -10 °C induced significantly higher summed symptom scores for eye irritation 2.0 vs 0.5 (p=0.011), rhinitis 12.0 vs 8.0 (p=0.000), nasal irritation 3.5 vs 0.5 (p=0.001), cold face 7.0 vs 1.0 (p=0.000), physical discomfort 6.5 vs 0.0 (p=0.000), and cold extremities 10.0 vs 0.5 (p=0.000).

    In healthy subjects, moderate-intensity exercise in -10 °C can induce and enhance the intensity of a wide range of symptoms. Symptoms of the lower airways were infrequent and mild.

  • 4. Ersson, Annika
    et al.
    Östman, Terese
    Sjöström, Rita
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Perceptions of Tuberculosis Among Individuals Born in a High-Endemic Setting, Now Living in a Low-Endemic Setting2019Ingår i: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 21, nr 6, s. 1373-1379Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Of all individuals diagnosed with tuberculosis (TB) in Sweden 2015 were 90% born in other countries. Early diagnosis and treatment is essential to avoid TB transmission. Lack of knowledge about TB and anticipated negative social consequences have proved to be significant contributing factors to delay in seeking health care. This study aimed to understand the perception of TB among people originating from a high-endemic region, currently living in a low-endemic region. A qualitative study design, with male and female participants from a high-endemic region divided into focus groups. A semi-structured interview guide was used to elicit their perceptions of TB. A qualitative content analysis was performed on the recorded material from the interviews. The informants noted that their attitude towards individuals with TB had changed, previously they had felt prejudiced towards them whereas now they felt supportive. It seems possible to diminish TB stigma by ensuring suitable health care is available in combination with correct information about transmission, infectiousness and treatment.

  • 5. Essner, Ann
    et al.
    Högberg, Hans
    Zetterberg, Lena
    Hellström, Karin
    Sjöström, Rita
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Region Jämtland Härjedalen, Unit of Research & Education & Development, Östersund, Sweden.
    Gustås, Pia
    Investigating the Probability of Response Bias in Owner-Perceived Pain Assessment in Dogs With Osteoarthritis2020Ingår i: Topics in Companion Animal Medicine, ISSN 1938-9736, Vol. 39, artikel-id 100407Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Owners' ability to recognize signs of chronic pain in dogs undergoing pharmacologic and nonpharmacologic pain interventions during a period of physical rehabilitation is not known. This study aimed to compare dogs with and without chronic pain, and to assess the relationship between explanatory factors, including the probability of owners' response bias induced by pharmacologic and nonpharmacologic pain intervention, and chronic pain in dogs with osteoarthritis (OA). Seventy-one dogs with OA were included in this observational study. Owner-perceived pain interference was measured by Canine Brief Pain Inventory (CBPI) and owner-perceived pain behavior was assessed using Helsinki Chronic Pain Index. A dichotomous variable of Helsinki Chronic Pain Index was used in regression analysis to investigate the association between chronic pain and explanatory factors (body condition, anti-inflammatory medication, animal physiotherapy consultation once or more and owners' perception of pain interfering). Seventy-five percent of the dogs had ongoing anti-inflammatory medication, 51% of were overweight and 45% had a physiotherapy consultation. Higher levels of overt pain behaviors were reported in items addressing activities. Body condition, physiotherapy consultation and medication were not associated with chronic pain. Odds ratio (OR) and 95% confidence intervals of OR for the CBPI were 1.74 (1.23-2.47) and significantly associated with chronic pain. The adjusted OR of the CBPI did not differ from the crude OR. Owner-perceived pain behavior was not confounded by the dogs' medication. Results indicated that CBPI was not mediated by the medication. The CBPI pain interference score was not associated with response bias and may be used as clinical outcome measure of chronic pain and pain-related disability in dogs with OA along a period of physical rehabilitation comprising pharmacologic and nonpharmacologic pain interventions. 

  • 6. Essner, Ann
    et al.
    Zetterberg, Lena
    Hellström, Karin
    Gustås, Pia
    Högberg, Hans
    Sjöström, Rita
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Psychometric evaluation of the canine brief pain inventory in a Swedish sample of dogs with pain related to osteoarthritis2017Ingår i: Acta Veterinaria Scandinavica, ISSN 0044-605X, E-ISSN 1751-0147, Vol. 59, artikel-id 44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To evaluate intervention, implement evidence-based practice and enhance the welfare of dogs with naturally occurring osteoarthritis (OA), access to valid, reliable and clinically relevant outcome measures is crucial for researchers, veterinarians and rehabilitation practitioners. The objectives of the present study were to translate and evaluate psychometric properties, in terms of internal consistency and construct validity, of the owner-reported measure canine brief pain inventory (CBPI) in a Swedish sample of dogs with pain related to OA.

    Results: Twenty-one owners of clinically sound dogs and 58 owners of dogs with pain related to OA were included in this observational and cross-sectional study. After being translated according to the guidelines for patient-reported outcome measures, the CBPI was completed by the canine owners. Construct validity was assessed by confirmatory factor analysis, by repeating the principal component analysis and by assessing for differences between clinically sound dogs and dogs with pain related to OA. Internal consistency was estimated by Cronbach's a. Confirmatory factor analysis was not able to confirm the factor-structure models tested in our sample. Principal component analysis showed a two-component structure, pain severity and pain interference of function. Two components accounted for 76.8% of the total variance, suggesting an acceptable fit of a two-component structure. The ratings from the clinically sound dogs differed from OA dogs and showed significantly lower CBPI total sum. Cronbach's a was 0.94 for the total CBPI, 0.91 for the pain severity and 0.91 for the pain interference of function.

    Conclusions: The results indicate that the translated version of the CBPI is valid for use in the Swedish language. The findings suggest satisfying psychometric properties in terms of high internal consistencies and ability to discriminate clinically sound dogs from OA dogs. However, based on the confirmatory factor analysis, the original factor structure in the CBPI is not ideally suited to measure pain related to OA in our sample and the hypothesis of the presented two-factor structure was rejected. Further research needs to be conducted to determine whether the original psychometric results from CBPI can be replicated across different target groups and particularly with larger sample size.

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  • 7.
    Harryson, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Strandhälsan–Health Care Centre, Falkenberg, Sweden.
    Sjöström, Rita
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Provoked vulvodynia from a patient perspective: physiotherapy made a difference2024Ingår i: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Vulvodynia is considered to be a common cause of sexual pain in women of reproductive age and has a significant negative impact on their psycho-sexual health and quality of life. This study aimed to investigate the felt and known experience of living with provoked vulvodynia (PVD) in a group of women in Sweden and to explore the support, information, and treatment perceived to be important based on experienced symptoms.

    Methods: Ten women recruited by staff, from the vulva clinic at two hospitals in Sweden, participated in individual interviews. The results were analysed using qualitative content analysis.

    Results: The analysis resulted in the overarching theme ‘The women’s dilemmas regarding a sustainable daily life’. This theme is based on the difficulties the women experienced in being listened to and getting information and treatment to have the quality of life they want. Most important was understanding their own body, understanding the purpose of the treatment, and getting manual guidance to break the fear of pain.

    Conclusion: The results give a detailed picture of women’s experiences of PVD and delineate components of treatment perceived as important. This interview study is significant for healthcare professionals involved as the knowledge can contribute to faster diagnosis and better patient-specific treatment. The study may also guide future healthcare-related political decisions and the patient flow for these patients.

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  • 8.
    Köpsén, Sofia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Lilja, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Hellgren, Margareta
    The Skaraborg Institute, Sweden; Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy, The University of Gothenburg, Gothenburg, Sweden.
    Sandlund, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sjöström, Rita
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Midwives' and diabetes nurses' experience of screening and care of women with gestational diabetes mellitus: a qualitative interview study2023Ingår i: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2023, artikel-id 6386581Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Gestational diabetes mellitus (GDM) is increasing and is associated with adverse outcomes for both mother and child. The metabolic demands of pregnancy can reveal a predisposition for type 2 diabetes mellitus (T2DM), and women with a history of GDM are more likely to develop T2DM than women with normoglycemic pregnancies.

    Aim: The aim of this study was to explore midwives' and diabetes nurses' experience of their role in screening, care, and follow-up of women with gestational diabetes mellitus and, further, to explore their opinions and thoughts about existing routines and guidelines.

    Method: Individual interviews were performed with ten diabetes nurses and eight midwives working in primary and special care. Qualitative content analysis was done according to Graneheim and Lundman.

    Results: The analysis of the interviews resulted in the overall theme "An act of balance between normalcy and illness, working for motivation with dilemmas throughout the chain of health care."Difficulties in carrying out the important task of handling GDM while at the same time keeping the pregnancy in focus were central. Women were described as highly motivated to maintain a healthy lifestyle during pregnancy with the baby in mind, but it seemed difficult to maintain this after delivery, and compliance with long-term follow-up with the aim of reducing the risk of T2DM was low. The women came to the first follow-up but did not continue with later contact. This was at a time when the women felt healthy and were focusing on the baby and not themselves. A lack of cooperation and easy access to a dietician and physiotherapist were pointed out as well as a wish for resources such as group activities and multiprofessional teams.

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  • 9.
    Köpsén, Sofia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Krokom Health Care Center, Region Jämtland Härjedalen, Krokom, Sweden.
    Sjöström, Rita
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Unit of Research, Education and Development, Region Jämtland Härjedalen, Östersund, Sweden.
    Patients' Experiences of a Stress-Management Programme in Primary Care2020Ingår i: Journal of Multidisciplinary Healthcare, E-ISSN 1178-2390, Vol. 13, s. 207-216Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Stress and stress-related ill health have a multifactorial impact; both on physical and mental health. To better meet this category of patients a primary care unit started a stress-management programme using cognitive behavioural therapy and basic body awareness therapy. Purpose: To describe participant's experiences of a primary care stress-management programme using cognitive behavioural therapy and basic body awareness therapy.

    Methods: In a qualitative study, a semi-structured interview guide was used in individual interviews with 9 people, all women aged 41-57, working or on sick leave, who had enrolled in the stress-management programme. The material was analysed through qualitative content analysis.

    Results: The analysis resulted in the theme "Process of change for a sustainable everyday living". The participants described having gained awareness of the symptoms of their stress, knowledge and tools to manage their stress, ways to relax, awareness of their body, and the means to develop better habits and to change their behaviour. Fundamental in the material was the importance of participants' identification with the others in the group.

    Conclusion: The participants started a process of change with new knowledge and growth, but they encountered difficulties and obstacles. Behavioural change is a time-consuming process.

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  • 10.
    Persson, Lovisa
    et al.
    Hammarstrand Health Care Centre, Östersund, Sweden.
    Sjöström, Rita
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    A compulsory school in need of a physiotherapist: an interview study2024Ingår i: International Journal of Adolescence and Youth, ISSN 0267-3843, E-ISSN 2164-4527, Vol. 29, nr 1, artikel-id 2341939Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Physical activity among schoolchildren is declining. Increased physical activity and motor training in school have shown good effects on health, learning and school performance. Physiotherapists can cooperate with school staff, but there are challenges in terms of environment and working methods. The study aim was to explore the attitude of compulsory school staff to physiotherapeutic competence in school and in student health care. Interviews were conducted with school staff and student health care team members. Data were analysed with qualitative content analysis. Based on categories and subcategories, a theme was identified as The physiotherapist as a piece of the student health care team puzzle. The staff were positive about the competence, gave suggestions on work areas, and could see advantages to including a physiotherapist on staff. More studies are needed in the field, especially regarding inclusion of physiotherapists in teams that work to promote health and prevent illness and injury.

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  • 11.
    Sjöström, Rita
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden.
    Kaev, Gunilla
    The Coordination Agency of the Region of Jämtland, Östersund, Sweden.
    Söderström, Lars
    Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden.
    Evaluation of a Health-Management Course for Recently Settled Immigrants2022Ingår i: Journal of International Migration and Integration, ISSN 1488-3473, E-ISSN 1874-6365, Vol. 23, nr 1, s. 365-381Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study aims to evaluate an intervention, consisting of nine weeks of health-management course, combined with social and working life orientation and language instruction for recently settled immigrants in Sweden. One hundred one participants in the intervention groups and 48 participants in the control group participated. The intervention consisted of a health management course combined with social and working life orientation and the control group participated in the regular local authority program for social and working life orientation. Measurement instruments were health-related quality of life (HRQoL) and registration of work rate. Several participants in the groups were in work, primarily in subsidized employment, after six months. Recently settled men were employed to a greater extent than the women, where poorer physical and mental health could be observed among women in this study. Participants in the intervention and the control groups had maintained HRQoL from pre-intervention to six months post-intervention. More studies investigating the participants experiences of the health-managing course but also more homogenous measurements in studies for recently settled immigrants are needed.

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  • 12.
    Sjöström, Rita
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden.
    Söderström, Lars
    Klockmo, Carolina
    Patrician, Alexander
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Björklund, Glenn
    Hanstock, Helen
    Stenfors, Nikolai
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Qualitative identification and characterisation of self-reported symptoms arising in humans during experimental exposure to cold air2019Ingår i: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 78, nr 1, artikel-id 1583528Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Exposure to cold air is associated with increased morbidity and mortality in the general population. It is difficult to study the effects of whole-body exposure to cold air under controlled conditions in real life. Objectives: The aim of this study was to (1) explore and describe the experience of symptoms in humans during experimental and controlled exposures to cold air, by using controlled environmental chamber exposures and qualitative methodology, and to (2) categorise the symptoms. Method: The study used a randomised, double blind design, in which 34 subjects undertook rest and moderate-intensity exercise in an environmental chamber set to two or three different temperatures (0, -10, and -17 degrees C) on separate occasions. During the chamber exposures, subjects were interviewed. Qualitative content analysis was selected as the method of analysis. Findings: Subjects reported 50 distinct symptoms during the exposures. The symptoms were grouped into ten sub-categories and two major categories; airway versus whole-body symptoms. Conclusion: We have identified a broad range of symptoms in humans undertaking rest and moderate-intensity exercise at sub-zero temperatures. The symptoms and their categories may well be used to more extensively and quantitatively map cold-induced morbidity.

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